Individual
LEROY THOMAS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3205 CHURCHLAND BLVD, CHESAPEAKE, VA 23321-5205
(757) 484-7822
(757) 484-7362
Mailing address
3205 CHURCHLAND BLVD, CHESAPEAKE, VA 23321-5205
(757) 484-7822
(757) 484-7362
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
4301406300
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477633980
NPI
AL
01
—
BLUE CROSS
51109153
AL
Enumeration date
10/17/2006
Last updated
02/15/2013
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